MEDICARE: BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA OU PHYSICIANS TULSA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician
2	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1396770707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA OU PHYSICIANS TULSA

Provider Business Mailing Address
First Line	:	4502 E. 41ST STREET. 2G08
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-2553
Country	:	US
Telephone Number	:	918-660-3632
Fax Number	:

Provider Business Practice Location Address
First Line	:	1105 EAST 33 STREET NORTH
Second Line	:	BCCHS HAWTHORNE ELEMENTARY
City	:	TULSA
State	:	OK
Zip	:	74106
Country	:	US
Telephone Number	:	918-660-3614
Fax Number	:	918-660-3631

Authorized Official
Title or Position	:	CEO OU PHYSICIANS
Name	:	BRIAN L MADDY
Credential	:
Telephone Number	:	405-271-3932

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	09/11/2025

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